This is called a Talar Osteochondral Lesion or OLT. 17 The affected bone and its covering of cartilage may stay in place and not cause any symptoms, or a fragment may gradually loosen and cause pain. OCLs (osteochondral lesions of the talus) consist of damage or minor fractures to cartilage's surface on the lower bone of the talus (ankle joint). 11. 2013 Jun 5;95(11):1045-54. doi: 10.2106/JBJS.L.00773. View Aetiology infection. We have developed a team of consultants that have expertise in a myriad of treatments for the thousands of ankle arthritis patients out there. This information is an overview of the management of osteochondral lesions of the talus and is not all inclusive. Up and Down arrows will open main level menus and toggle through sub tier links. Wagner KR, DeFroda SF, Sivasundaram L, Kaiser JT, Meeker ZD, Condron NB, Cole BJ. This young 40 year old patient had little options for this size of OCD lesion and he is only six weeks out but off of narcotics and only on Advil. Brostrum), medial malleolar osteotomy for medial and posterior lesions, longitudinal incision centered over medial malleolus, flexor retinaculum released posteriorly; PTT retracted posteriorly, osteotomy guided based of 2 parallelly placed K-wires, with goal to enter plafond at lateral extent of OLT, prior to osteotomy, 2 drill holes placed to aid in reduction following procedure, sagittal saw and osteotome used to complete osteotomy, care taken not to cause thermal necrosis to bone or damage cartilage, lateral malleolar osteotomy or ATFL/CFL release for lateral lesions, longitudinal incision centered over lateral malleolus, oblique osteotomy planned, with predrilling of small fragment screws holes to aid in reduction following procedure, alternatively, if lateral ligament reconstruction is planned, extensor retinaculum may be released, peroneal tendons retracted posteriorly and ATFL and CFL released, ankle inverted and plantarflexed to expose talar dome, OLT debrided and measured using sizing guide, appropriately sized autograft may be harvested from knee and placed into OLT, impacted gently into defect, OATs harvested from the knee have a cartilage thickness less than the native talus, this will cause immediate post-operative xrays to show a prominent graft despite the cartilage surface being flush, do not release deltoid ligament as may jeopardize deltoid artery blood supply, ankle impingement if graft plug left proud, arthroscopic harvest of chondrocytes (from ankle or alternatively from knee) are sent for cultured growth, open approach via osteotomy for implantation, debridement of lesion to create stable cartilage rim, subchondral bone exposed, bone graft may be placed if underlying cyst and bone loss, periosteum from tibia taken and fitted to defect, this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect, water-tight seal confirmed, cultured chondrocytes placed under flap and suture placed, fibrin glue placed over defect, newer technique of matrix-based chondrocyte implantation (MACI) shown equivalent outcomes to ACI and may obviate need for osteotomy, small percentage of patients do not achieve pain relief regardless of treatment, Lesions may progress to involve entire ankle joint, Posterior Tibial Tendon Insufficiency (PTTI). Foot Ankle Clin. anklearthritiscenters Dr. Cottom and Dr. McAlister have operated on numerous patients and trained in all the treatment options necessary to treat all severity levels of OCD in the talus. Enjoy your weekend! View The .gov means its official. Keywords: Arthroscopy uses a camera and small instruments to view and work within the joint through small incisions. Osteochondral Lesions of the Talus are focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage which may be caused by a traumatic event or repetitive microtrauma. View MeSH Ankle valgus. Complications, such as infection or wound healing problems, are uncommon after arthroscopic ankle surgery. There are several non-operative management options for the treatment of osteochondral lesions, including: In younger patients, this condition has the potential to heal, making it possible to treat acute non-displaced talar OLTs with immobilization in a cast or CAM walker. Federal government websites often end in .gov or .mil. Weight bearing immobilization in walking cast for 1 week, then early mobilization have better recovery and prognosis. Areas of decreased density (i.e., darker areas) seen on the plain x-rays (Figure 2) can be indicative of this condition, although it is not uncommon for the plain x-rays to be read as normal. We are committed to providing expert caresafely and effectively. It is recommended that you avoid bearing weight to your ankle for at least 6-8 weeks until your ankle has healed. Follow on Instagram Ten patients were operated on the dominant side and 14 patients had accompanying talus osteochondral lesions (OLT). . None of the patients and healthy control group were sports professionals. Focal medial shoulder talar osteochondral defect (OCD or OLT). Figure C shows the corresponding MRI. Foot Ankle Orthop. With this type of injury, a section of the talus surface may impact another part of the ankle joint (tibia or fibula) and injure the talus. This prevents the need from harvesting bone and cartilage from another part of the body (ex. It is suggested that even in chronic lesions, arthroscopic surgery can yield a high percentage of excellent or good results with minimal morbidity, brief hospitalization, and a rapid recovery time for the patient by avoiding long skin incisions and deep soft tissue dissections, grooving of the distal tibia, or osteotomy of the medial malleolus. Enjoy your weekend! . An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). Conclusion. For smaller and less severe lesions, BMS techniques can initiate your bodys healing process to self-repair while avoiding any damage to healthy cartilage. #anklereplacement #footarthritis #footfusion He will do great! Over time, the synthetic bone graft will be resorbed and replaced by your native bone. Tibial component was also loose. 14 They can occur after ankle trauma, such as sprains or fractures, but they usually present as a continued ankle pain after the initial injury has resolved. anklearthritiscenters The type of surgery depends on the size of the defect and the extent of bone and cartilage loss. It is this area where the drill holes are . 3 Does anyone know why this happened? Feb 22 "Osteo" means bone and "chondral" refers to cartilage. This patient was over 13 years out and had no history of wounds or prev. anklearthritiscenters Ankle valgus. A challenging case of talar AVN in Sarasota Florida with Dr Cottom. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). The goal of non-surgical treatment is to allow the injured cartilage and bone to heal. Ankle sprains are a common cause of OLTs. for professional medical advice, diagnoses or treatments. Treatment depends on the severity of the osteochondral injury. She would like to know her options. 69 The talus is a unique bone heavily covered in articular cartilage that is necessary to provide pain-free range of motion within the ankle joint. Open Some lesions may be more appropriately treated with surgery. Adjacent subtle marrow edema seen in the medial aspect of talus bone. Careers. Patients may have an OLT that doesn't cause pain or limitations or a lesion that becomes painful but improves. This treatment approach can be initially attempted in non-displaced OLTs, Physical therapy: working on strengthening the muscles around the ankle, range of motion of the ankle, and balancing (proprioception), Protective braces (ex. View If you have any underlying conditions that may predispose to an OLT such as ankle instability, ankle impingement, a high arched (cavovarus) foot, or tight calf muscles, it may be necessary to correct these problems at the time of surgery as well. Appointments. Come see if your ankle replacement is intact and functioning well!! The term osteochondritis dissecans was originally applied to lesions of the talar dome of the ankle by Kappis ( 1) in 1922 referring to abnormalities of the articular cartilage and underlying subchondral bone which can result in fragment separation and loose body formation. Knee Surg Sports Traumatol Arthrosc. Diagnostic block performed. Tags: talar dome fracture , ankle pain , bone problems , stress fracture Recommended Products Ankle Lacer) to decrease stress can also be utilized, Arthroscopic debridement (cleaning out) and microfracture of the talar OLT. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Avoidance of dancing with CAM walker boot for 2 weeks, Shoulder360 The Comprehensive Shoulder Course 2023, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Evolving Technique Update: Role Of An Osteotomy In The Treatment Of An Osteochondral Lesion Of The Talus - Phinit Phisitkul, MD, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique Update: MSCs For Cartilage Repair: Let Me Show You How - Italy Guides The Way - Alberto Gobbi, MD, 2019 Orthopaedic Summit Evolving Techniques, Debridement And Abrasion: It's Simple And Yields Great Results: Watch Me! Posttraumatic Tibial Plateau Lesions with Fresh Osteochondral Allograft . EFORT Open Rev. Plan for multiple procedures here!!! An osteochondral allograft may be an option if the defect is very large, but this tends not to be as successful as one might hope for a number of reasons, one of which is that the area where the. A small subset of symptomatic osteochondral lesions of the talus involve subchondral pathology with intact overlying articular cartilage; in these cases, retrograde drilling into the cystic lesion can be employed to induce underlying bony healing. It was once thought that all OLTs progress and worsen with time, but this is no longer believed to be true. If the bone is only bruised and the lesion is stable (without loose pieces of cartilage or bone), non-surgical treatment may alleviate symptoms. She does not have RA or any other rheumatologic disorder. Impaired function, limited range of motion, stiffness, catching, locking and . Its painful- come learn a way to get past it. The defects cause deep ankle pain associated with weightbearing. 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